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Allen, Ricky C
Bureau of Vital Records Name First Middle Last Sex Male Rickey C.Allen Date of Death Age If Veteran of U.S.Armed Forces, 06/29/2021 48 Years War or Dates H Place of Death Hospital,Institution or z City,Town or Village Day Town Street Address 101 Hollow Road,Day Town,New York 12835 tL Manner of Death Undetermined Pending `p ©Natural Cause Accident Homicide Suicide U Circumstances Investigation W Medical Certifier Name Title Q David DeCelle Coroner Address 40 McMaster Street,Ballston Spa,New York 12020 District Number Register Number Death Certificate Filed 4 City,Town or Village Hadley 4554 El Burial Date Cemetery,Crematory or Facility Name 07/02/2021 Pine View Crematory ❑Entombment Address ElCremation Queensbury Town,New York O Donation Date Place Removed 0 Removal and/or Held and/or Hold Address N 0 Date Point of u) Li Transportation Shipment p by Common Carrier Destination Date Cemetery Address ElDisinterment Date Cemetery Address 0 Reinterment Registration Number Permit Issued to 00211 Name of Funeral Home Brewer Funeral Home Inc Address 24 Church Street PO Box 500,Lake Luzerne,New York 12846 Name of Funeral Firm Making Disposition or to Whom l. Remains are Shipped,If Other than Above L Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. 07/01/2021 Registrar Vital Statistics Carol Vaillancourt(Electronically Signed) Date Issued g (signature) District Number 4554 Place Hadley, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: ~ Place of Disposition .)0c, V i�w Gef,"Q-IC z Date of Disposition a.-J-o�-1 address) W W (lot number) (grave number) U) � (section) GName of Sexton or Person in Charge of Premises rrmt/u 5 ld,ft-S (please print) z G rt,,ena-�C1r Signature Title W DOH-1555(07/18)p 1 of 2 C #asuaat'[so•Eag sio;aaJ1Q jvzaunq jE?ar p I inu.zad pun'uo pau.Tu amoq'mum aqi Suuuasaida21 klaiamaD main aujd. OZ uo paaanijap 3o sureuzaa unumH tiidraaag (QZ)StIt '33S mul uUIuaH DIFInd 0/(14%.* No i